Blood pressure and prognosis in patients with incident heart failure: the Diet, Cancer and Health (DCH) cohort study

BACKGROUND: Our objective was to test the hypothesis that elevated blood pressure (BP) is associated with increased risk of stroke, bleeding and death in patients with incident heart failure (HF).

METHODS: We conducted a prospective cohort study among subjects who were participants in the Diet, Cancer and Health study, born in Denmark, aged 50-64 years at recruitment. We assessed stroke (ischemic stroke or systemic embolic events), major bleeding, death and the composite endpoint according to degree of BP control in patients with incident HF. BP was assessed prior to HF at cohort entry.

RESULTS: Of the whole cohort of 55,748 subjects, n = 2159 (35 % female) had incident HF, of which 12 % had treatment for hypertension. Median follow-up after incident HF was 3.5 years. High systolic (SBP), diastolic (DBP) and pulse (PP) pressures were associated with an increased risk of stroke, major bleeding and the composite endpoint. For death and stroke/death, the relation appeared U-shaped for SBP and DBP. When comparing the highest quartile group (Q4) to first quartile group (Q1), SBP (Q4: SBP >163 mmHg) was associated with significantly higher adjusted hazard rate ratio (HR) for stroke (HR 1.46, 95 % CI 1.00-2.14) and major bleeding (HR 1.68, 95 % CI 1.12-2.53). For DBP (Q4: DBP >94 mmHg), adjusted HR was significantly higher for major bleeding (HR 1.63, 95 % CI 1.13-2.38). The highest quartile of pulse pressure (Q4: PP >74 mmHg) was associated with non-significantly higher risk of stroke (HR 1.40, 95 % CI 0.94-2.06).

CONCLUSION: We have shown for the first time that amongst a population with incident HF, higher baseline systolic, diastolic and pulse pressure levels were associated with a higher rate of adverse events. Our data support the importance for optimised BP control, as part of the holistic management of HF patients.